<sigh> yet another request for dosing for (preventing?) AP

[WhatHaveIGottenMyselfInto]

Hello,

I'm once again in possession of Eastern Greys in a state where it's hard to get them help. (my screen name refers to an encounter I had with an adult eastern grey in very poor condition a couple of years ago - with the state's permission, we were able to see a vet and euthanasia was recommended - this round of squirrels is definitely manageable and a joy)

Long story short:
I have had a squirrel in my care since TUESDAY September 17th that in his enthusiasm for finally being warm and cared for after some prolonged neglect and conspecific aggression got a little too greedy with his formula and aspirated on THURSDAY evening. On Friday he seemed to have cleared it, but the clicking is more pronounced today (SATURDAY) and he seems to be breathing heavily. He is still happily slurping his formula, though he's frustrated we're back to a 1ml syringe and no miracle nipple.

I want to start him on antibiotics given that the aspiration doesn't seem to be clearing and due to that he's not gained weight since we've had him - holding at 159g.
This is Squirrel #2 - joining a baby we have had in our care since September 1st (Squirrel #1)... there seems to have been a preggers mom squirrel intent on evicting babies from a drey in our yard. Between Squirrel #1 and Squirrel #2, there was even an emaciated baby that fell to their death from the drey. My point being, we were already immersed in the Henry's squirrel care protocol and equipped with Fox Valley 20/50, Henry's blocks of every variety and a heating pad that doesn't switch off when Squirrel #2 arrived.

Squirrel #1 is doing great. He was ~120g Sept 1st and well over the 210g when I last weighed him.*

Bottom line:
6-7 weeks old (if he's truly nest mate of Squirrel #1)
159 grams for the last few days
Hydration is still iffy - we have been alternating formula with honey water
Aspirated two days ago. Clicking but still loves formula

I happen to have on hand - as I’m currently medicating a chicken with lash egg - 2ml to spare of trimethoprim-sulfmethoxazole 100mg/ml.

I'll start dosing him as soon as someone replies.
In addition to antibiotics, what other support can I provide?

Many thanks,
E



*after we have this cleared up, we'll be researching "overwintering" - 'cause, do you agree, it's too late to plan on a release? Anyhoo, first things first. Thanks.

[SamtheSquirrel2018]

BUMP! BUMP!
Sorry no response yet 12 hours from original post!
I'm at work! I'll get back just as soon as I am able! Hopefully others will see this and respond ASAP!
SamtheSquirrel

[Charley Chuckles]

I can't dose but again this thread will get bumped

[lachy22]

[ASPIRATION CLICKING / DOSING HELP NEEDED]

Hello, Could you record a video of Squirrel#2's aspirating/breathing and post it as an unlisted link on Youtube and link it to this post?

Hello,

I'm once again in possession of Eastern Greys in a state where it's hard to get them help. (my screen name refers to an encounter I had with an adult eastern grey in very poor condition a couple of years ago - with the state's permission, we were able to see a vet and euthanasia was recommended - this round of squirrels is definitely manageable and a joy)

Long story short:
I have had a squirrel in my care since TUESDAY September 17th that in his enthusiasm for finally being warm and cared for after some prolonged neglect and conspecific aggression got a little too greedy with his formula and aspirated on THURSDAY evening. On Friday he seemed to have cleared it, but the clicking is more pronounced today (SATURDAY) and he seems to be breathing heavily. He is still happily slurping his formula, though he's frustrated we're back to a 1ml syringe and no miracle nipple.

I want to start him on antibiotics given that the aspiration doesn't seem to be clearing and due to that he's not gained weight since we've had him - holding at 159g.
This is Squirrel #2 - joining a baby we have had in our care since September 1st (Squirrel #1)... there seems to have been a preggers mom squirrel intent on evicting babies from a drey in our yard. Between Squirrel #1 and Squirrel #2, there was even an emaciated baby that fell to their death from the drey. My point being, we were already immersed in the Henry's squirrel care protocol and equipped with Fox Valley 20/50, Henry's blocks of every variety and a heating pad that doesn't switch off when Squirrel #2 arrived.

Squirrel #1 is doing great. He was ~120g Sept 1st and well over the 210g when I last weighed him.*

Bottom line:
6-7 weeks old (if he's truly nest mate of Squirrel #1)
159 grams for the last few days
Hydration is still iffy - we have been alternating formula with honey water
Aspirated two days ago. Clicking but still loves formula

I happen to have on hand - as I’m currently medicating a chicken with lash egg - 2ml to spare of trimethoprim-sulfmethoxazole 100mg/ml.

I'll start dosing him as soon as someone replies.
In addition to antibiotics, what other support can I provide?

Many thanks,
E



*after we have this cleared up, we'll be researching "overwintering" - 'cause, do you agree, it's too late to plan on a release? Anyhoo, first things first. Thanks.

[SamtheSquirrel2018]

Hello again,
I just had a moment to look at you original post. I am not familiar with the 100mg/ml preparation of Trimethoprim/Sukfamethoxazole.


Would you please post photos of the labels from both sides of the bottle!
Just for clarification, what is the 100mg that is contained in 1ml? Is this the weight of the Trimethoprim component or the Sulfamethoxazole component or is it the combined weight of both?
Thanks and again, sorry for the delays!
Regards,
SamtheSquirrel

[SamtheSquirrel2018]

Hello again,
I just had a moment to look at you original post. I am not familiar with the 100mg/ml preparation of Trimethoprim/Sukfamethoxazole.


Would you please post photos of the labels from both sides of the bottle!
Just for clarification, what is the 100mg that is contained in 1ml? Is this the weight of the Trimethoprim component or the Sulfamethoxazole component or is it the combined weight of both?
Thanks and again, sorry for the delays!
Regards,
SamtheSquirrel

Hi WhatHaveIGottenMyselfInto:
I am home for most of the evening and can help with dosing or whatever but it is essential for proper dosing instructions to have the answers to the questions about this particular medication you have available!

What is the name of your Squirrel and how is your Squirrel doing now?

Would you please describe the specifics about the aspiration event such as what was being fed, how did you recognize that an aspiration had occurred, were there immediate breathing difficulties, were any actions taken to possibly lessen the effects of an aspiration such as holding the Squirrel downward or whatever, and anything else that comes to mind that may help result in a full history.

Regards,
SamtheSquirrel

[WhatHaveIGottenMyselfInto]

Hi WhatHaveIGottenMyselfInto:
I am home for most of the evening and can help with dosing or whatever but it is essential for proper dosing instructions to have the answers to the questions about this particular medication you have available!

What is the name of your Squirrel and how is your Squirrel doing now?

Would you please describe the specifics about the aspiration event such as what was being fed, how did you recognize that an aspiration had occurred, were there immediate breathing difficulties, were any actions taken to possibly lessen the effects of an aspiration such as holding the Squirrel downward or whatever, and anything else that comes to mind that may help result in a full history.

Regards,
SamtheSquirrel

Hello SamtheSquirrel,

Thank you for answering. I've had many family commitments today and more squirrel time than screen time.

1st, current status: holy moly that little body worked something out last night. This morning he was active, had almost no noticeable/audible breathing sounds and had gained his first weight... retaining 9 grams in the 24hrs since last weighing. And, no, I don't think it's bloat. So he'd been 159 since we got him on Tuesday and then was 168g this morning. Same scale.
He's still very bony but better hydrated today. Lots of pee... sometimes it's smelly, as was the first squirrels initial urination once hydrated again. I'll watch to see if urine become odorless as it did for SN1...

Names:
Our family hasn't settled on names in part because we're trying to remember they're from the wild and to the wild will return. So Squirrel Number One and Squirrel Number Two... but old memories of organic chemistry have me shortening them to SN1 and SN2 (reactions). They're AKA Rose Hips and Scratch, respectively. Or Thing 1 and Thing 2.

Aspiration events:
Fox Valley 20/50, 2parts water, 1part formula
I thought we had hit a stride in nursing so I had upgraded on Thursday to the 10ml o-ring syringe from Henry's that we'd been using with lots of success with Sn1.

There were two successive formula feedings on Thursday when he just got SOOOO enthused and inhaled formula, milk going everywhere, coming from nose, coughing, sputtering. It put him off the rest of the meal and the audible hitch with every breath after that.

After the second aspirating meal, yes, I inverted. I also went out and purchased two different infant nasal syringes to apply some very gentle suction while hubs held inverted. Had no apparent effect - though using the Swedish Snot Sucker (NoseFrida) on a squirrel can now be checked off my bucket list. I even reversed the mechanism incase the mouthpiece fit his nose better.

Subsequent nursings:
Last night and today we've been doing well with 3-4 3ml syringes with the miracle nipple attached.

Prescription:
The medication label is a pretty generic prescription label as it's sourced from a nearby animal compounding pharmacy. (image attached... I think)

Every mention I could find of Bactrim and the two specific drugs in it have them same proportion, 5 parts sulfamethoxazole to 1 part trimethoprim (wow... that's some handy autofill on those drug names), just different strengths. So I wonder if in 100mg/ml it's 16.666mg trimethoprim to 83.333mg sulfamethoxazole. What do you think?

I'll reach out to the compounding pharmacy Monday when they're open and ask for specifics.

I feel that his marked improvement has given us breathing room.
Today, whenever I hold him up to my ear, all I can hear is his little heart purring away. Only every once in a while I think I've heard a deeper click when breathing.

Two things we recently changed: 1) removed the heating pad from under the carrier he was in (it was only under part of it, but I think it was still too warm... or squirrel wasn't behaviorally thermoregulating as he should (ie moving to cooler part when needed) and 2) this morning we moved him to another cage and in the same room as SN1 where they can see each other (pictured, SN2 in foreground).

I'll let you know what I learn from the pharmacy and if conditions change.

Thank you! Thank you! Thank you!

[SamtheSquirrel2018]

Aspiration events:
Fox Valley 20/50, 2parts water, 1part formula
I thought we had hit a stride in nursing so I had upgraded on Thursday to the 10ml o-ring syringe from Henry's that we'd been using with lots of success with Sn1.

There were two successive formula feedings on Thursday when he just got SOOOO enthused and inhaled formula, milk going everywhere, coming from nose, coughing, sputtering. It put him off the rest of the meal and the audible hitch with every breath after that.

After the second aspirating meal, yes, I inverted. I also went out and purchased two different infant nasal syringes to apply some very gentle suction while hubs held inverted. Had no apparent effect - though using the Swedish Snot Sucker (NoseFrida) on a squirrel can now be checked off my bucket list. I even reversed the mechanism incase the mouthpiece fit his nose better.

Subsequent nursings:
Last night and today we've been doing well with 3-4 3ml syringes with the miracle nipple attached.

Thanks for your reply, WHIGMI!
Just a couple of comments about the syringes; I believe that you discovered (I guess the hard way) that a 10ml syringe is way to large for a baby Squirrel and should never be used for feeding! That being said, even a 3ml syringe increases risk of aspiration over use of one or multiple 1ml syringes! With larger babies and with experienced feeders with ABSOLUTE CONTROL over the plunger; a 3ml syringe may be acceptable but---! The factors that increase the risk of an aspiration event are those factors that would tend to increase flow rate such as the size of the syringe itself or make it difficult to maintain control of the plunger such as using a plunger without an o-ring seal. The
o-ring helps minimize the likelihood of a sudden change in resistance of the plunger and a resultant sudden increase in flow rate!

Prescription:
The medication label is a pretty generic prescription label as it's sourced from a nearby animal compounding pharmacy. (image attached... I think)

Every mention I could find of Bactrim and the two specific drugs in it have them same proportion, 5 parts sulfamethoxazole to 1 part trimethoprim (wow... that's some handy autofill on those drug names), just different strengths. So I wonder if in 100mg/ml it's 16.666mg trimethoprim to 83.333mg sulfamethoxazole. What do you think?

I'll reach out to the compounding pharmacy Monday when they're open and ask for specifics.

I feel that his marked improvement has given us breathing room.
Today, whenever I hold him up to my ear, all I can hear is his little heart purring away. Only every once in a while I think I've heard a deeper click when breathing.

I'll let you know what I learn from the pharmacy and if conditions change.

As far as this prescription; you can easily see where my confusion arises (most often, others have no idea why I am confused)! In human medicine, most dosing of TMP/SMZ is based upon the Trimethoprim component and it is consistently a 5:1 ratio of sulfamethoxazole to Trimethoprim as you noted!

In Exotic Animal Veterinary medicine, it is often the combined weights of both components or as in Human medicine, the Trimethoprim component. Some common Exotic animal Veterinary formularies or general Small Animal Formularies differ and some are simply unclear and the assumption I make it is not stated is that when lower numbers are used in the dosing ranges that are consistent with dosing based upon the Trimethoprim component, then that is what I use and if significantly higher dosing amounts are listed that are consistent with formularies that state specifically that the combined weights of both components are used in calculation; I use the combined weights. This is not the greatest system but the fault lies with the formularies that don't specify how their dosing recommendations are calculated!

Going back to your preparation; this is obviously quite ambiguous and knowing specifically how this was formulated would, IMHO, be essential before it would be considered for use on your Squirrel and maybe not even then! Do you have any other antibiotics available?

I agree with your assessment of having some "breathing room." I assume that the pun was intended! I am not going to get into the "clicking" specifically but I use a stethoscope (actually an amplified stethoscope to listen to my Squirrels (and other small animals). One common abnormal type of breath sound that can be associated with a pneumonia (NOT diagnostic of pneumonia, however) is the presence of what are called Crackles (some use the older term, Rales) which have the sound and characteristics that you might hear if you rubbed several strands of hair together right beside your ear. Crackles are almost never heard without a stethoscope even in humans so it can be said definitively that you will not hear Crackles from a baby Squirrel by standing next to it or listening with your unaided ears! The "clicking" that many talk about; I have the same opinion; and that is this "clicking" cannot originate from a tiny animal's lungs and if it does occur, it must be from the larger airways in the nose or throat or is associated with the sounds from mouth breathing which include teeth contacting other teeth (all mouth breathing in Squirrels is abnormal). Mouth breathing can certainly result from an aspiration that obstructs or interferes with normal nasal breathing.

Please keep on with updates on your Squirrels!

Regards,
SamtheSquirrel

[WhatHaveIGottenMyselfInto]

Thanks for your reply, WHIGMI!

As far as this prescription; you can easily see where my confusion arises (most often, others have no idea why I am confused)! In human medicine, most dosing of TMP/SMZ is based upon the Trimethoprim component and it is consistently a 5:1 ratio of sulfamethoxazole to Trimethoprim as you noted!

In Exotic Animal Veterinary medicine, it is often the combined weights of both components or as in Human medicine, the Trimethoprim component. Some common Exotic animal Veterinary formularies or general Small Animal Formularies differ and some are simply unclear and the assumption I make it is not stated is that when lower numbers are used in the dosing ranges that are consistent with dosing based upon the Trimethoprim component, then that is what I use and if significantly higher dosing amounts are listed that are consistent with formularies that state specifically that the combined weights of both components are used in calculation; I use the combined weights. This is not the greatest system but the fault lies with the formularies that don't specify how their dosing recommendations are calculated!

Please keep on with updates on your Squirrels!

Regards,
SamtheSquirrel

I was able to stop by the compounding pharmacy today to ask about the formulation. The pharmacist said it's a 1:4 concentration of Trimethoprim to Sulfamethoxazole for a total dose of (in my chicken's case) 100mg/ml.
Both squirrels are doing well and enjoying the other's company.

[SamtheSquirrel2018]

I was able to stop by the compounding pharmacy today to ask about the formulation. The pharmacist said it's a 1:4 concentration of Trimethoprim to Sulfamethoxazole for a total dose of (in my chicken's case) 100mg/ml.
Both squirrels are doing well and enjoying the other's company.

Thanks for the update! I'm glad your Squirrels are doing well and they certainly appear healthy! Good job, WHIGMI! Are you still planning a Soft-Release for Rose Hips and Scratch?
Regards,
SamtheSquirrel

[WhatHaveIGottenMyselfInto]

Are you still planning a Soft-Release for Rose Hips and Scratch?
Regards,
SamtheSquirrel[/QUOTE]

Absolutely want to do a soft release, but I'm thinking we're going to have to overwinter. We have mild wet winters in the Willamette Valley of Oregon. Are there good resources about overwintering outside in a release cage? Almost exclusively I see references to overwintering indoors. I also have a lead on an in-state squirrel rehabber as an alternative to crossing state lines to the Squirrel Refuge in Vancouver. Scratch weighed 300 grams today He needs to join his brother on the exercise wheel.

[SamtheSquirrel2018]

Are you still planning a Soft-Release for Rose Hips and Scratch?
Regards,
SamtheSquirrel

Absolutely want to do a soft release, but I'm thinking we're going to have to overwinter. We have mild wet winters in the Willamette Valley of Oregon. Are there good resources about overwintering outside in a release cage? Almost exclusively I see references to overwintering indoors. I also have a lead on an in-state squirrel rehabber as an alternative to crossing state lines to the Squirrel Refuge in Vancouver. Scratch weighed 300 grams today He needs to join his brother on the exercise wheel.[/QUOTE]

Hello WhatHaveIGottenMyselfInto:
I'm glad that your Squirrels are doing well! As far as overwintering, there is probably no real reason this can't be accomplished outdoors BUT the usual reasons for overwintering is that they are at least a bit young for them to go into the Release Cage before winter sets in or they are just at the cusp where most of us would want to let the Squirrel start out its life in the wild in Spring and have the benefits of having nearly three fairly hospitable seasons to become fully acclimated to the wild and have their natural instincts fully active before a cold, harsh Winter sets in! If you do feel inclined to overwinter (and that seems to be a good idea at their age), can you keep them in their indoor enclosure during that period? Have you already constructed a fully functional Release Cage with a small portal located high on the cage? If not, overwintering will permit you some time to construct this necessary special cage! If you have truly mild Winters and you have the Release Cage constructed and you want to keep them outside, it would probably amount to an extended Soft-Release! You would need to have a contingency plan if weather or temperatures become formidable and you would need to ensure that the Squirrels were adequately protected from predators. If temperatures become unexpectedly cold or worse yet approaching freezing, IMHO I would then bring them inside and really, WHIGMI; if there is any chance of that, I would like to suggest just keeping them inside until Spring!

Please keep on with the updates!
Regards,
SamtheSquirrel